Urinary retention
Urinary retention means the bladder cannot empty completely. Acute urinary retention is a sudden inability to urinate despite a full bladder and is an emergency; chronic retention can develop gradually with few symptoms but may damage the bladder or kidneys over time.
At a glance
Quick facts
- Category
- Bladder emptying disorder
- Acute form
- Sudden inability to urinate
- Chronic form
- Incomplete emptying over time
- Key test
- Postvoid residual urine
- Immediate acute treatment
- Bladder drainage
- Common causes
- Obstruction or weak bladder contraction
Dr. Francis Chibueze Nwokpoku
Medical Officer · 9th Division Hospital, Nigerian Army
Reviewed for clinical accuracy, important omissions and patient-facing safety wording.
Names & terminology
How this entity may be named or searched
- Acute urinary retention
- Sudden inability to pass urine despite a full bladder; usually painful and requires urgent drainage.
- Chronic urinary retention
- Persistent incomplete bladder emptying that develops gradually and may cause few symptoms.
- Postvoid residual (PVR)
- The amount of urine remaining in the bladder after urination.
- Overflow incontinence
- Leakage that can occur when a chronically overfilled bladder cannot empty effectively.
Structured entity profile
Clinical profile
Overview
Urinary retention occurs when urine cannot leave the bladder normally or the bladder muscle cannot generate enough force to empty. Obstruction from BPH or urethral narrowing is common, but neurologic disease, pelvic organ prolapse, constipation, medicines and anesthesia can also contribute. [1]
Acute urinary retention is a sudden complete or near-complete inability to urinate and can cause severe pain and kidney injury. Chronic retention develops more slowly; some people continue to pass urine and therefore do not realize the bladder is retaining a large residual volume. [1]
Symptoms and warning signs
Acute retention typically causes inability to urinate, severe lower-abdominal discomfort and a strong urge to void. Chronic retention can cause weak stream, hesitancy, frequent small voids, a feeling of incomplete emptying, urinary leakage or few symptoms. [1]
SYMPTOM MATRIX
Acute and chronic urinary retention can look very different
Sudden complete inability to urinate is an emergency even when the cause is not yet known.
- Weak or interrupted stream
- Difficulty starting urination
- Feeling of incomplete emptying
- Frequent small voids
- Overflow leakage
- Nocturia
- Lower-abdominal fullness
- Recurrent urinary infections
- Reduced bladder sensation
- Few or no symptoms
- Sudden inability to urinate
- Severe lower-abdominal pain or distension
- Retention with fever or systemic illness
- Retention with new leg weakness or saddle numbness
Acute urinary retention requires urgent bladder drainage and evaluation of the cause.
Diagnosis
Postvoid residual measurement is the key test: ultrasound or catheterization measures how much urine remains in the bladder after urination. History focuses on urinary symptoms, prostate disease, operations, neurologic problems, childbirth and medicines that can impair bladder emptying. [2]
Urinalysis and blood tests assess infection and kidney function. Ultrasound, CT, MRI, cystoscopy or urodynamic testing may be used when clinicians need to identify obstruction, neurologic dysfunction or another structural cause. [2]
Diagnostic pathway
Drain acute retention first, then determine why the bladder is not emptying
For chronic retention, residual volume and the effect on kidneys or infections guide urgency.
A post-void residual is interpreted with symptoms, repeat measurements and clinical context; one value alone does not define every case of chronic retention. Source [2]
Common causes
Urinary retention can result from bladder outlet obstruction or weak bladder contraction. Causes include BPH, urethral stricture, stones or tumors; neurologic disease; pelvic organ prolapse; constipation; medicines with anticholinergic or sympathomimetic effects; and temporary postoperative or anesthesia-related dysfunction. [1]
Treatment and management
Acute urinary retention is treated by immediately draining the bladder, usually with a urinary catheter. This relieves pain and helps protect the bladder and kidneys while clinicians investigate the cause. [3]
Once the cause has been identified and addressed, the need for an indwelling catheter should be reassessed and a trial without catheter considered when clinically appropriate.
Chronic retention is managed by treating the underlying cause and ensuring safe bladder emptying. Depending on the cause, treatment can include intermittent or indwelling catheterization, BPH medicines, treatment of urethral stricture or pelvic organ prolapse, medication review, neurologic bladder management or surgery. [3]
Treatment & care hub
Protect the bladder and kidneys while treating the cause
Urgency depends on whether retention is acute, infected or affecting kidney function.
Empty the bladder promptly
Catheter drainage is the immediate treatment for acute urinary retention.
Maintain safe bladder emptying
Some patients use intermittent catheterization while the underlying cause is treated or long-term.
Relieve the outlet problem
BPH, urethral stricture, prolapse or other structural causes may need medicine or a procedure.
Address weak bladder contraction
Neurologic or myogenic retention may require urodynamic evaluation and a long-term bladder-emptying plan.
Why chronic retention matters
Urine left in the bladder can contribute to urinary tract infection, overflow incontinence and progressive bladder dysfunction. If pressure is transmitted to the upper urinary tract, kidney swelling and kidney damage can occur. [4]
Older-men risk estimate
Acute urinary retention becomes more common with age in men
NIDDK cites a five-year risk of about 1 in 10 men over age 70 and almost 1 in 3 men in their 80s.
Common questions
Frequently asked questions
No. In retention the kidneys may be making urine, but the bladder cannot empty it normally. Very low urine production is a different problem.
Yes. Sudden inability to urinate with a full bladder requires urgent drainage and evaluation.
A postvoid residual measurement shows how much urine remains after urination; additional tests identify the cause and complications.
Yes. Prostate enlargement can obstruct the urethra and is a common cause of retention in older men.
No. Catheterization may be temporary or intermittent, and long-term management depends on whether the underlying cause can be corrected.
Sources
- NIDDK, NIH — Urinary Retention
- NIDDK, NIH — Diagnosis of Urinary Retention
- NIDDK, NIH — Treatment of Urinary Retention
- NIDDK, NIH — Definition & Facts of Urinary Retention
This article is based on trusted medical sources and has undergone clinician review. It is not a substitute for personalized medical advice.
Acute urinary retention needs prompt assessment and bladder decompression rather than waiting for the problem to resolve on its own.